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Early Reverse Cardiac Remodeling Effect of Laparoscopic Sleeve Gastrectomy

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Abstract

Background

This study evaluated the early postoperative benefits of laparoscopic sleeve gastrectomy (LSG) on the left ventricular (LV) function and left atrial (LA) structural, mechanical, and electrical functions in severely obese patients.

Methods

Thirty-two patients with severe obesity who were consecutively scheduled for LSG and 30 healthy controls were included in the study. LV global longitudinal strain (LGS), peak atrial longitudinal strain (PALS), and strain rates (S-Sr, E-Sr, and A-Sr) of the lateral and septal LA walls, and intra- and interatrial dyssynchrony periods for all subjects were evaluated using strain echocardiography. The measurements were repeated in patients 1 month after surgery.

Results

LGS of the LV was significantly depressed in the patient group compared with the control group (p < 0.001). LA peak septal and lateral wall strain values were significantly lower in patients than in controls (both p values <0.001). LA intra- and interatrial dyssynchrony periods were longer in patients than in controls (p = 0.012 and p = 0.004, respectively). LGS significantly improved after LSG (p < 0.001). Significant reductions were noted in the LA antero-posterior diameter (p < 0.001), LA volume index (LAVI, p = 0.001), and in the mitral velocity to the early diastolic velocity of the mitral annulus ratio (E/e’ ratio, p = 0.046). The PALS of the septal and lateral LA walls significantly increased (p = 0.001 and p < 0.001, respectively). S-Sr, E-Sr, and A-Sr values of the septal LA wall (p = 0.049, p < 0.001, and p = 0.001, respectively) and the lateral LA wall (p = 0.009, p = 0.007, and p = 0.002, respectively) significantly improved postoperatively. Intra- and interatrial dyssynchrony significantly decreased (p = 0.001 and p < 0.001, respectively). Weight loss positively correlated with changes in LGS (R = 0.39, p = 0.039), LAVI (R = 0.39, p = 0.034), intra-atrial dyssynchrony (R = 0.45, p = 0.021), interatrial dyssynchrony (R = 0.42, p = 0.038), septal LA wall peak strain (R = 0.44, p = 0.027), lateral LA wall peak strain (R = 0.46, p = 0.017), septal LA wall A-Sr (R = 0.43, p = 0.028), and lateral LA wall A-Sr (R = 0.46, p = 0.019). The comparison of postoperative findings of the patients with controls revealed that the LA diameter, both LA volume and volume index (LAVI), E/e’ ratio, S-Sr and E-Sr of both lateral and septal LA walls, intra- and interatrial LA dyssynchrony of the patient group became similar to the control group (all p value >0.05). Postoperative A-Sr values of both LA walls (both p value <0.001) were higher in patients than controls.

Conclusion

The benefits of LSG on LV and LA function may be observed even in the early postoperative phase. The resulting weight loss correlates with LV and LA reverse remodeling in severely obese patients.

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Authors and Affiliations

  1. Department of Cardiology, Karşıyaka State Hospital, Izmir, Turkey

    Kamil Tuluce, Nurullah Cetin, Caner Topaloglu & Yasemin Turhan Bozkaya

  2. Department of General Surgery, Karşıyaka State Hospital, Izmir, Turkey

    Cemal Kara

  3. Department of Cardiology, Izmir Katip Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey

    Selcen Yakar Tuluce

  4. Department of Internal Medicine, Izmir University Faculty of Medicine, Division of Endocrinology and Metabolism, Izmir, Turkey

    Ali Saklamaz

  5. Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey

    Cahide Soydas Cinar

  6. Department of Cardiology, Dokuz Eylül Faculty of Medicine, Izmir, Turkey

    Oktay Ergene

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  1. Kamil Tuluce
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Correspondence to Kamil Tuluce.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Tuluce, K., Kara, C., Tuluce, S.Y. et al. Early Reverse Cardiac Remodeling Effect of Laparoscopic Sleeve Gastrectomy. OBES SURG 27, 364–375 (2017). https://doi.org/10.1007/s11695-016-2301-2

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